Hāpai Te Hauora has criticised the Asthma foundation for scaremongering as lobbying pressure builds over how e-cigarettes will be regulated by the new Government.

December 16, 2017

Hāpai Te Hauora has criticised the Asthma foundation for scaremongering as lobbying pressure builds over how e-cigarettes will be regulated by the new Government.

The Asthma and Respiratory Foundation responded this week to a media report – quoting the Ministry of Health saying vaping is much safer than smoking – by saying that it feared the Ministry was providing one-sided advice and it called for strict regulation of e-cigarettes to avoid a “potential public health disaster in the future”.

The Ministry of Health put out a position paper in October 2017 stating it believed e-cigarettes were lower risk than smoking, though not risk free, and could ‘contribute’ towards reaching the Smokefree 2025 goal. Meanwhile the second of the yearly tobacco tax hikes is due on January 1 and will bring a packet of 20 cigarettes to around $27.50.

Hāpai Te Hauora, the Māori Public Health agency that provides the National Tobacco Control Advocacy Service, said the Foundation’s “scaremongering tactics” could be putting the Smokefree 2025 goal “at risk by attempting to influence the new Government to turn its back” on the previous government’s “pragmatic” proposal to legalise e-cigarettes. A recent visiting Italian asthma and e-cigarette researcher also supported the Ministry’s stand saying his research indicated smokers switching to e-cigarettes had a similar reversal of lung damage results to people who quitted smoking and his own research had found no pathology difference between vapers and non-vapers after three and a half years of monitoring.

Foundation medical director Dr Stuart Jones said it recognised that for a “small number of current smokers” who struggle to quit that e-cigarettes may be “beneficial” but it believed that existing quitting support with a “proven record” should be the first call and that regulation should limit e-cigarette sales to existing smokers.

“The current situation in which e-cigarettes can be marketed including Thomas the Tank shaped vaporisers and fruit loop flavoured liquids is clearly not designed as a marketing strategy for cessation but rather to attract a younger generation of New Zealanders,” said Jones. “There is no good reason for children, or indeed non-smokers to use these products as they will cause damage in the lungs.”

Hāpai Te Hauora said it supported the Ministry of Health (see excerpts from the Ministry’s 2011 positive position statement on e-cigarettes below) and previous ministers’ “progressive” stance on regulating e-cigarettes as a “pragmatic” pathway for people becoming smokefree. The new Health Minister David Clark and his Associate Minister Jenny Salesa – who is responsible for tobacco control – are yet to decide on whether the new Government will follow through on the previous Government’s plan to introduce e-regular legislation in 2018.

Dr Lance O’Sullivan, national advisor for Hāpai Te Hauora, said he sees the effects of smoking on a day-to-day basis as a GP in Kaitaia.

“If it was really as simple as just telling people to quit, a smokefree Aotearoa would have been achieved years ago,” said O’Sullivan. “But the reality is that it’s bloody hard to quit, and we have seen little change in Māori smoking rates. We need to open our minds to new approaches to eliminating tobacco harm, and the fact is e-cigarettes are less harmful than tobacco.”

He said e-cigarettes are working for many Māori and there was emerging evidence that supported their efficacy for helping people to stop smoking.

Hāpai advocate for e-cigarettes and their use and regulation alongside reducing the supply of traditional tobacco to help meet the Smokefree 2025 goal.

O’Sullivan said it had seen a “sustained campaign against e-cigarettes from the Foundation”. “We urge the Minister of Health David Clark and Associate Minister of Health with responsibility for tobacco control Jenny Salesa to consider carefully their response to this lobbying activity from the Asthma and Respiration Foundation as a wrong step now will put Smokefree 2025 out of reach for our most affected communities.”

Dr Jones, who is also the local branch president of the Thoracic Society, said it recommended not only restricting the sales of e-cigarettes to existing smokers but also that e-cigarettes are part of a proper wraparound smoking cessation programme by the Ministry of Health involving health professionals at a primary and community care level.

O’Dwyer said the Foundation didn’t want youth enticed to take up vaping. “E-cigarettes and vaping products should have the same restricted sale and accessibility placed on them as conventional cigarettes e.g. prohibit sale and supply in public places, not sold to under 18 year olds and no point of sale advertising of e-cigarettes and e-liquids.”

She said that several studies were also emerging indicating that e-cigarettes could be a gateway to smoking. A recently published study, ‘Trajectories of E-Cigarette and Conventional Cigarette Use Among Youth’ in the January 2018 edition of Pediatrics (Official Journal of the American Academy of Pediatrics) concludes the following:

“E-cigarette use was associated with future cigarette use across 3 longitudinal waves, yet cigarette use was not associated with future e-cigarette use. E-cigarette regulation and prevention programs may help prevent future use of cigarettes among you.”

Dr Jones said there was “a huge concern around the flavours used in the inhaled products that have had no testing that they are actually safe to inhale”.

“This includes additives of which currently more than 7000 of them are food products. The stomach is very different to the lungs. There are a raft of studies demonstrating many of them are toxic to lung cells especially chocolate and berry. There are also currently no consumer safety requirements for these products.”

O’Dwyer also raised concerns that there was “significant conflict of interest” on the Ministry of Health Electronic Cigarette Technical Expert Advisory Group with three industry representatives (including a buyer for Cosmic retail stores) giving advice on Electronic Cigarette Product Safety.

“It’s greatly concerning that the Ministry of Health does not have a balanced and evidence based Expert Advisory Group. In contrast, many of the people in the group will benefit from the sales of e-cigarettes and vaping products, it doesn’t make sense that these same people are advising us on the safety of these products.”

Ministry of Health Key Messages*

The best thing smokers can do for their health is to quit smoking for good

E-cigarettes are intended for smokers only

The Ministry believes e-cigarettes could disrupt inequities and contribute to Smokefree 2025

The evidence on e-cigarettes indicates they carry much less risk than smoking cigarettes but are not risk free

The Cochrane Review found that e-cigarettes can help people to quit smoking, but acknowledges that the evidence is weak due to little data

Smokers who have tried other methods of quitting without success could be encouraged to try e-cigarettes to stop smoking. Stop smoking services should support smokers using e-cigarettes to quit

There is no international evidence that e-cigarettes are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it

Despite some experimentation with e-cigarettes among never smokers, e-cigarettes are attracting very few people who have never smoked into regular e-cigarette use

When used as intended, e-cigarettes pose no risk of nicotine poisoning to users, but e-liquids should be in child resistant packaging

The Ministry of Health is identifying safety standards for e-cigarettes in New Zealand. In the meantime, vapers should buy their products from a reputable source like specialist retailers.